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Evaluation of Trabecular Bone Score and Bone Mineral Density in Patients with Primary Hyperparathyroidism under 50
Yunkyung Jeon1, Myungsoo Im1, Doohwa Kim1
1Division of Endocrinology and Metabolism, Department of Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
Insights
Young adults with primary hyperparathyroidism (PHPT) have poorer bone quality and microarchitecture, even with normal bone mineral density (BMD). This indicates early bone deterioration, highlighting the need for advanced assessment tools.
Area of Science:
- Endocrinology
- Bone Metabolism
- Gerontology
Background:
- Normocalcemic primary hyperparathyroidism (PHPT) affects bone health.
- Assessing bone status in younger adults with PHPT is crucial.
- Limited data exists on bone quality in normocalcemic PHPT patients under 50.
Purpose of the Study:
- To compare densitometric characteristics and qualitative bone status in young adults with PHPT versus controls.
- To evaluate bone mineral density (BMD) and trabecular bone score (TBS) in PHPT patients.
- To explore correlations between bone parameters and laboratory markers in PHPT.
Main Methods:
- Retrospective study of 31 PHPT patients and 60 controls (age < 50).
- Dual-energy X-ray absorptiometry (DXA) of lumbar spine (LS), femoral neck (FN), and total hip (TH).
- Trabecular Bone Score (TBS) derived from LS DXA; BMD assessed using Z-scores.
Main Results:
- PHPT patients had significantly lower median TBS than controls.
- BMD Z-scores did not significantly differ between groups at individual sites.
- Serum intact parathyroid hormone negatively correlated with TBS in PHPT patients.
Conclusions:
- Young adults with PHPT show impaired bone quality and microarchitectural deterioration despite preserved BMD.
- Combined assessment of LS/femoral BMD and TBS is recommended for skeletal health evaluation in PHPT.
- Early detection of bone changes in PHPT is vital for timely intervention.
Background:
This study aimed to investigate the densitometric characteristics and qualitative bone status in patients with normocalcemic primary hyperparathyroidism (PHPT) compared with those in controls who were younger adults under 50 years.
Methods:
This retrospective study included 60 controls and 31 patients with PHPT who underwent dual energy X-ray absorptiometry (DXA) of the lumbar spine (LS), femoral neck (FN), and total hip (TH). Trabecular bone score (TBS) was derived from LS DXA images. Bone mineral density (BMD) values were assessed using Z-scores, and correlations between TBS, BMD, and laboratory parameters were examined.
Results:
The median ages of the control and PHPT groups were 41 and 42 years, respectively. The proportion of individuals classified as "below the expected range for age" based on Z-scores differed significantly between groups only when considering any site collectively. Median TBS was significantly lower in PHPT patients than in controls, even when BMD values at LS, FN, and TH fell within similar diagnostic categories. In controls, TBS and BMD demonstrated very low correlation coefficients. In contrast, PHPT patients showed a stronger correlation between TBS and femoral BMD, whereas the association between TBS and LS BMD was largely absent. Among laboratory markers, only serum intact parathyroid hormone was significantly negatively correlated with TBS.
Conclusions:
Young adults with PHPT exhibit impaired bone quality despite relatively preserved BMD, suggesting early microarchitectural deterioration. These findings support the combined use of LS and femoral BMD with TBS for more accurate assessment of skeletal health in PHPT.
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